In this review we focus on sublingual immunotherapy (SLIT), toll like receptor-9 (TLR-9) vaccines, and anti-IL-5 as novel immunomodulating therapies in allergy. SLIT provides a novel oral route of administering an allergen to induce tolerance to inhaled allergens. Studies of SLIT in allergic rhinitis demonstrate that it reduces symptoms and medication use and is associated with a low incidence of systemic allergic reactions. Initial phase II studies with TLR-9 vaccines conjugated to a ragweed allergen demonstrate that they reduce symptoms of allergic rhinitis during the ragweed season. Anti-IL-5 is effective as a corticosteroid sparing agent in the hypereosinophilic syndrome. In contrast, anti-IL-5 has not shown benefit in moderate asthmatics with persistent symptoms, but may reduce features of airway remodeling in asthma. At present all these immunomodulating approaches (SLIT, TLR-9 vaccines, and anti-IL-5) are investigational in the USA and require further study to determine their safety and effectiveness.
Keywords: sublingual immunotherapy, subcutaneous immunotherapy, anti-IL-5, TLR-9, tolerance